Toxicology Flashcards
salicylates fatal ingestion amount?
10-30g
activated charcoal for salicylates?
if within 1 hour
goal of treatment for salicylate overdose?
alkalosis, serum ph 7.5-7.59, urine pH 6.5-8
how does alkalosis work in salicylate overdose?
favors the unprotonated anion and is excreted in the urine, if protonated it can cross the BBB
Level when to use HD in salicylate OD?
severe sx, >120 mg/dl in serum, or >100 6 hr post ingestion
isopropyl alcohol acid base?
only osmolar GAP, no AGAP, no acidosis, but ketones in urine
breakdown product of isopropyl?
acetone- smelly breath
osmolar gap?
serum osm- calc osm, normal <10
calculated osmolarity?
2Na+BUN/2.8+glc/18
treatment for isopropyl alcohol ingestion?
fluids and pressors if needed
HD for isopropyl alcohol?
level >500, coma, resistant sx
ethylene glycol(antifreeze) breaks down into?
oxalate
oxalate effect? how does it look?
renal failure/ dumbell shaped crystals
Methanol breaks down into what?
formic acid
alcogol dehydrogenase does what?
methanol to formaldehyde
alcohol dehydrogenase is inhibited by what 2 things?
ethanol(level 100-150 mg/dl) and fomepizole
formic acid causes what?
blurred vision, photophobia, blindness, optic disc hyperemia
methanol and ethylene glycol acid base?
osmolar gap and AGAP
propylene glycol tox seen in what circumstance?
dilutent in lorazepam infusion
propylene glycol acid bae?
AGAP, osmolar GAP, AKI, lactic acidosis
CCB overdose tx?
calcium, glucagon, lipid emulsion, insulin .1-10U/kg
why cant you use dialysis for CCB overdose?
highly protein bound
tx for BB OD?
glucagon, lipid emulsion
MC tx for BB OD?
atropine and fluids
how does glucagon work in BB OD?
inc cAMP, inc contractility
symtpoms of BB OD?
bronchospasm, hypoglycemia, AV block, bradycardia
CCB OD tx?
high dose calcium, then high dose insulin, then lipid emulsion therapy
MOA of high dose insulin in CCB OD?
increases ical leading to increase ionotropy
high dose insulin dosing?
1U/kg bolus, then 1-10 U/kg/hr. make sure to fix K and glc prior
pathophys of methemoglobinemia?
contains the Fe3 instead of Fe2 which shifts the oxygen dissociation curve left and has higher affinity for o2 and does not unload to tissues
how to measure methemoglobinemia?
co oximetry levels with methemoglobin levels, >30% severe
causes of methemoglobinemia?
topical benzocaine, dapsone, primaquine, rasburicase in G6PD patients
tx for methemoglobinemia?
methylene blue
patient with low sat that is not responsive to supplemental O2, but normal Po2?
methemoglobinemia
MOA of acetaminophen toxicitiy?
overwhelming the glutatione conjugation
time frame for giving charcoal in acetaminophen tox?
within 1 hour
tx for acetaminophen OD?
16h NAC protocol
poor prognostic factors with tylenol OD?
acidosis, renal failure, INR>6, grade III HE
when not to use the Rumack Matthew nomogram?
chronic tylenol use, chronic alcohol use, preexisting liver disease, unknown time of ingestion
treatment for heavy metal intoxication?
dimercaprol
how does insulin work for CCB OD?
Chronotropy and ionotropy
when to transfer to a liver center for tylenol OD?
early signs of hepatic dysfucntion or massive ingestion of >30g or a serum level of >500 mg/L
ethylene glycol urine findings?
calcium oxalate monohydrate crystlas, dumbbell shaped
initial management strategy for acetaminophen overdose?
if confirmed give NAC, dont wait for lab value
best treatment for isopropyl alcohol intoxication?
IV fluids, HD reserved for levels over 500 and severe symptoms
aspirin overdose electrolyte disturbances?
low serum uric acid, lactic acid from uncoupling, hypokalemia, AGAP acidosis, resp alkalosis
complication from salicylate toxicity need to watch for?
hypoglycemia
